Lord Warner: I hesitate to detain the Committee much longer on this subject, but I need to respond to one or two points. I shall deal with the subject of York later in my remarks.

The noble Countess, Lady Mar, drew attention to some concerns about fluorosis. I commend to her again the statements on this matter in the briefing from the Chief Medical Officer and the Chief Dental Officer. I urge other Members of the Committee who are concerned about dental decay to look at some of the statistics at the front of the briefing. It indicates, for example, that in the north of England in the school year 200102, 44 per cent of five year-old children had active tooth decay and each of those had on average three and a half decayed teeth. I shall not relay any more statistics.

It is no good wishing to stop tooth decay and ignoring the evidence from the Chief Dental Officer and the Chief Medical Officer in the conclusion to their briefing:

"From a public health perspective water fluoridation is the delivery method of choice to bring about population improvements in dental health".

That is the nub of the issue and that is what to some extent is behind the Bill.

The noble Lord, Lord Fowler, did better than I could in rehearsing the history of this subject. He was supported ably by, as was described earlier, some of the West Midlands mafia. I believe that the evidence in relation to Birmingham is very powerful. My noble friend Lord King told us about the experiences of Sandwell.

During the course of the debate, a number of questions were raised about the way that we treat water and the addition of chemicals to water. Perhaps I may pass on to the Committee the advice that I have been given. A number of chemicals used in water treatment can be toxic at high concentrations. All drinking water in England and Wales is normally disinfected by the controlled addition of low concentrations of chlorinea highly toxic chemical.

9 Jul 2003 : Column 358

The water industry is used to dealing with those water treatment processes safely to ensure that dosing is strictly controlled within the target concentrations. Two chemicals used in fluoride are themselves the subject of European standards which require strict purity criteria. There are additional controls on the use of fluoridation chemicals within the code of practice, which itself will be revised. That ensures that levels of impurity and trace elements from the mineral rock used during manufacture are very low. Fluoride is effectively removed by the coagulation process, which is normally part of the water treatment process on water abstracted from rivers.

Therefore, considerable safeguards are built into the way that we treat our water and the way that we use it. Fluoride is reduced during sewage treatment. I suggest that that limits any potential environmental impacts. I am also advised that in animalsnoble Lords were concerned about this matterthere is no evidence of any effects from water with fluoride at concentration levels of up to 1.5 parts per million.

The noble Lord, Lord Monson, took us on a tour of Europe. I should like to take us on a tour of the world with regard to fluoridation. Throughout the world it is estimated that about 210 million people drink artificially fluoridated water and that a further 103 million drink water whose natural fluoride levels are high enough to provide a significant degree of protection against tooth decay. Countries with fluoridation schemes include the United States, Canada, Mexico, Argentina, Ireland, Spain, Australia, New Zealand, Hong Kong and Singapore. Many other countries have enacted the necessary legislation but have not yet introduced schemes. It is worth mentioning that the US is extending its fluoridation schemes. Therefore, we should not keep our attention only on what is happening in Europe.

The noble Baroness, Lady Byford, asked what would happen in areas within different strategic health authorities that may take a different view on the matter. I believe that the position is clear. The areas to be fluoridated will need to be identified at the beginning of the process. That will be dependent on the water treatment works that supply the area. Consultation will have to include all those who will be supplied with the fluoridated water. That could be part of a strategic health authority area or a combination of strategic health authorities. The water treatment processes occur in different parts of the country and, in many places, there would need to be a degree of consultation between different strategic health authorities.

Baroness Byford: Perhaps the noble Lord will give way. This is one of the problems that we are now facing. We are being asked to approve something on which, as he just said, consultation is still taking place. The Government do not really know what will happen. I may have misunderstood the situation, but we are faced with that problem tonight. That information should be before us prior to our being asked to support the amendment.

9 Jul 2003 : Column 359

Lord Warner: I am trying to say that water treatment plants do not fit neatly into the areas of strategic health authorities. Therefore, we must have a process of consultation between different strategic health authorities where there may be a wish to have fluoridation. That will have to take place in consultation with the water authorities, companies and undertakers, which will want to be able to explain to health authorities the areas covered by their treatment plants. With due respect to the noble Baroness, I do not believe that, at this late hour, the Committee is well equipped to have a debate about the precise allocation of water treatment plants in this country in relation to particular strategic health authorities.

A number of noble Lords, including the noble Baroness, Lady Byford, returned to the subject of the consultation process. Yet again, I shall try to be as clear as I can. We recognise the importance of the methods used in assessing public opinion. The word "referendum" never passed my lips. We shall hold wide discussions on this method of consultation. Noble Lords asked who we would consult. The consultees would include companies which conduct public opinion surveys, the Electoral Reform Society, the Local Government Association and professional bodies concerned with public health and dentistry, among others. Therefore, we have a very good idea of the groups

Lord Stoddart of Swindon: I am most obliged to the noble Lord. Among the "others", will he include the Electoral Commission?

Lord Warner: We shall take away this issue and consider it. However, without being committed to particular forms of consultation, I am trying to explain to noble Lords that we have in mind to consult a very wide range of interests and bodies.

The noble Lord, Lord Stoddart, raised the subject of the European Convention on Human Rights. I am advised that in the only case under that convention concerning fluoridationthe Swiss casethe Office of the High Commissioner for Human Rights considered that it did not need to consider the issue of whether interference with the right to respect for private and family life arose because any such interference would in any event be justified.

I turn to the points that were raised in relation to the York study. I acknowledge the long and sustained interest of the noble Earl, Lord Baldwin, in fluoridation, and in particular the contribution that he made as a member of the advisory committee for the review conducted by the University of York. I did not mean to imply, and I do not believe that the Chief Medical Officer and the Chief Dental Officer meant to imply, that there were no reservations in that report. I certainly accept that the York team was critical of the quality of the research that it considered.

As the CMO and CDO's paper indicates, the department is taking steps to strengthen the evidence base. However, it is worth bearing in mind that in its

9 Jul 2003 : Column 360

conclusions at paragraph 12.4, the York report stated that with bone fracture and cancer studies the evidence is very balanced around the no effect mark. Very few of the possible adverse effects studied appeared to show a possible effect. York found no evidence of risk to overall health from fluoridation, a view that was confirmed by the Medical Research Council when we asked it to identify what further research needs to be undertaken. The department will continue with its research

8.15 p.m.

Earl Baldwin of Bewdley: I wonder whether the noble Lord has read a little further on, where the York report goes to some length to say that because of the short length of the study some adverse effects may not have shown up in the long distance. I must again correct him on the no evidence point. It did not find no evidence. For the rest, I agree entirely with his analysis.

Lord Warner: The quotation came directly from the report. I did not believe that the Committee would like the whole of the report read out.

We shall continue with our research programme, as I said, and monitor the outcome of the research conducted in other countries. That work is due for completion in the autumn, well before the Bill will have completed its passage through Parliament. We have made the regulations under which we want any new local consultations to be conducted.

We have had a very thorough debate about this issue. In a nutshell, the amendment provides for local communities, after consultation, and after an informed discussion, to take steps to give their strategic health authorities a clear message that they want their water to be fluoridated. On the evidence that I have heard today, I do not see a case for denying those communities that choice and I hope that the Committee will support the amendment.